Tags

Type your tag names separated by a space and hit enter

Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement?
Wien Klin Wochenschr. 2002 Jul 31; 114(13-14):524-9.WK

Abstract

OBJECTIVE

To establish eventual signs and symptoms suggestive for central nervous system involvement in children with multiple erythema migrans.

METHODS

Patients younger than 15 years with multiple erythema migrans, diagnosed at our department from 1996 to 2000, were included in this prospective study. Demographic, clinical and laboratory findings were obtained and compared for a group of patients with pleocytosis (interpreted as a sign of central nervous system involvement) and a group of children with normal cerebrospinal fluid findings.

RESULTS

Cerebrospinal fluid pleocytosis (cell counts > or = 5 x 10(6)/l) was detected in 55/214 (25.7%) children; it was lymphocytic in 94.5% of patients and ranged from 5 to 320 (median, 10 x 10(6)/l). Compared with the group with normal cerebrospinal fluid findings, patients with pleocytosis more often reported having had Lyme borreliosis in the past (8/55 versus 3/159; p = 0.0011), had longer incubation periods (25.5 versus 14 days; p = 0.0269), larger diameter of the largest erythema migrans at the time of first examination (10 versus 5.5 cm; p = 0.0055), higher frequency of associated systemic symptoms (45.5% versus 21.4%; p = 0.0011), positive meningeal signs (10.9% versus 1.9%; p = 0.0100), borrelial IgG antibodies in cerebrospinal fluid (3/49 versus 0/150; p = 0.0142) and B. burgdorferi s.l. isolated from cerebrospinal fluid (7/52 versus 1/147; p = 0.0004), but less often had mild initial disease (67.3% versus 88.7%; p = 0.0006).

CONCLUSIONS

Cerebrospinal fluid pleocytosis was detected in 25.7% of children with multiple erythema migrans. Although several clinical and laboratory abnormalities were present significantly more often in patients with elevated cell counts than with normal cerebrospinal fluid findings, discriminatory significance for the majority of these abnormalities was low, particularly because of low negative predictive values. In more than 2/3 of patients with pleocytosis the initial disease was mild, fewer than 1/2 reported systemic symptoms, and meningeal signs were expressed in only 11%.

Authors+Show Affiliations

Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia. maja.arnez@kclj.siNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12422594

Citation

Arnez, Maja, et al. "Children With Multiple Erythema Migrans: Are There Any Pre-treatment Symptoms And/or Signs Suggestive for Central Nervous System Involvement?" Wiener Klinische Wochenschrift, vol. 114, no. 13-14, 2002, pp. 524-9.
Arnez M, Pleterski-Rigler D, Luznik-Bufon T, et al. Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement? Wien Klin Wochenschr. 2002;114(13-14):524-9.
Arnez, M., Pleterski-Rigler, D., Luznik-Bufon, T., Ruzić-Sabljić, E., & Strle, F. (2002). Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement? Wiener Klinische Wochenschrift, 114(13-14), 524-9.
Arnez M, et al. Children With Multiple Erythema Migrans: Are There Any Pre-treatment Symptoms And/or Signs Suggestive for Central Nervous System Involvement. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):524-9. PubMed PMID: 12422594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement? AU - Arnez,Maja, AU - Pleterski-Rigler,Dusica, AU - Luznik-Bufon,Tatjana, AU - Ruzić-Sabljić,Eva, AU - Strle,Franc, PY - 2002/11/9/pubmed PY - 2003/1/17/medline PY - 2002/11/9/entrez SP - 524 EP - 9 JF - Wiener klinische Wochenschrift JO - Wien Klin Wochenschr VL - 114 IS - 13-14 N2 - OBJECTIVE: To establish eventual signs and symptoms suggestive for central nervous system involvement in children with multiple erythema migrans. METHODS: Patients younger than 15 years with multiple erythema migrans, diagnosed at our department from 1996 to 2000, were included in this prospective study. Demographic, clinical and laboratory findings were obtained and compared for a group of patients with pleocytosis (interpreted as a sign of central nervous system involvement) and a group of children with normal cerebrospinal fluid findings. RESULTS: Cerebrospinal fluid pleocytosis (cell counts > or = 5 x 10(6)/l) was detected in 55/214 (25.7%) children; it was lymphocytic in 94.5% of patients and ranged from 5 to 320 (median, 10 x 10(6)/l). Compared with the group with normal cerebrospinal fluid findings, patients with pleocytosis more often reported having had Lyme borreliosis in the past (8/55 versus 3/159; p = 0.0011), had longer incubation periods (25.5 versus 14 days; p = 0.0269), larger diameter of the largest erythema migrans at the time of first examination (10 versus 5.5 cm; p = 0.0055), higher frequency of associated systemic symptoms (45.5% versus 21.4%; p = 0.0011), positive meningeal signs (10.9% versus 1.9%; p = 0.0100), borrelial IgG antibodies in cerebrospinal fluid (3/49 versus 0/150; p = 0.0142) and B. burgdorferi s.l. isolated from cerebrospinal fluid (7/52 versus 1/147; p = 0.0004), but less often had mild initial disease (67.3% versus 88.7%; p = 0.0006). CONCLUSIONS: Cerebrospinal fluid pleocytosis was detected in 25.7% of children with multiple erythema migrans. Although several clinical and laboratory abnormalities were present significantly more often in patients with elevated cell counts than with normal cerebrospinal fluid findings, discriminatory significance for the majority of these abnormalities was low, particularly because of low negative predictive values. In more than 2/3 of patients with pleocytosis the initial disease was mild, fewer than 1/2 reported systemic symptoms, and meningeal signs were expressed in only 11%. SN - 0043-5325 UR - https://www.unboundmedicine.com/medline/citation/12422594/Children_with_multiple_erythema_migrans:_are_there_any_pre_treatment_symptoms_and/or_signs_suggestive_for_central_nervous_system_involvement DB - PRIME DP - Unbound Medicine ER -